FASEB journal : official publication of the Federation of American Societies for Experimental Biology | VOL. Suppl 36 1
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Targeted Electrical Stimulation of the Superior Laryngeal Nerve - A Potential Treatment for Dysphagia in ALS.

Publication Date May 1, 2022

Abstract

Electrical stimulation (ES) is a treatment for swallowing impairment (dysphagia) that uses surface electrodes on the anterior neck to repeatedly contract and strengthen swallowing musculature without evoking swallows. This treatment approach is generally avoided in ALS patients due to concerns over rapid muscle fatigue that may further compromise swallowing, breathing, and airway protection. However, swallowing is a sensorimotor reflex that relies on several "upstream" sensory, motor, and interneuron components that are also affected by ALS. We hypothesize that ES can be optimized for ALS by selectively stimulating the superior laryngeal nerve (SLN) to activate and treat the entire swallow reflex circuitry, rather than only the swallowing muscles. Our rationale is based on general knowledge that SLN stimulation reliably evokes swallowing in experimental studies. Here, our translational work establishes a safe and reliable ES-SLN protocol in a mouse model of ALS with dysphagia, and then adapts the protocol for use in humans. For protocol development, ALS mice (transgenic SOD1-G93A) underwent an invasive survival surgery at 6 months of age (clinical disease onset) for 30 minutes of direct ES-SLN based on our prior work: 40 Hz; anodal, charge balanced rectangular pulses (400 µs pulse width, 400 µs interphase delay); up to 800 uA intensity and continuous trains of 20-seconds ON, 10-seconds OFF. Respiratory rate was monitored via an abdominal pneumatic sensor. Swallowing function was assessed via monthly videofluoroscopy. For tra...

Concepts

Superior Laryngeal Nerve Superior Laryngeal Nerve Stimulation Respiratory Rate Mouse Model Of ALS Rapid Muscle Fatigue Electrical Stimulation Disease End Stage Swallowing In Humans Stimulus Train Μs Pulse Width

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